Medications for severe neck pain? Worst day ever!

[thirdeye33]

Would some people mind sharing what has worked for them? Any bad side effects from them ,too? This is worst day my neck pain has been since my car accident. Currently seeing a Chiropractor 2x week and now just started back up w/ PT for my lower back this week. I don't know what is going on, but it hurts so bad it brings me to tears. I couldn't get a hold of my pain management doc. today. I've been on heat all day...tried ice. Nothing.
I'll be calling him Monday, but I guess I wanted some suggestions from other people in similiar pain have taken. I want to be better prepared when he rambles off what he wants me to try(I won't do epidural injections and nobody will get me to change my mind on that.) I have been taking Tramadol(Ultram) for almost 6 months now and I think its lost its effectiveness. I'm up to 400mg a day and I have no relief anymore.Can you even be prescribe more than that? I don't know too much about meds, before the car accident I was in perfect health and never even opened an Asprin bottle. I also take a muscle relaxer(Zanaflex) a night and that helps me stay asleep. Just nervous about trying something new,since Tramadol has had no bad side effects for me and I'm prone to bad effects of meds.


*Severe whiplash/neck sprain from a MVA  in 2/2011 several Disc Herniations/Buldges C 5-6, C 6-7  L 2-3, L3-4, L4-5 ,L5-S1 w. anular tear w/ osteophtes and stenosis.
Mild sclerosis at C7-T1

[mellie4]

Well, first off, no, you shouldn't have taken the Norco.  When you're in pain management, you generally have to sign a contract.  If you deviate in any way from it, they can dismiss you immediately.  A lot of people have found that out the hard way.  Did you sign a contract?  If you did, please read it carefully.  You definitely need to have a frank talk with both your pain team and your chiropractor.  Just let the chiropractor know you need to take a break from it for now.  Let your pain management doctor know you're not having good pain control with the Tramadol.  Anyone who takes any narcotic for more than a short time will become physically dependent.  Even though Tramadol isn't technically a narcotic, it does bind to the opioid receptors and withdrawal is often worse than other narcotics as it has an antidepressant component to it.  I took Tramadol years ago for fibromyalgia but found it was not helpful at all with my pain.  I was only on it for a few weeks or a month at the most.

Gabapentin (Neurontin) and Lyrica are both used for pain.  They seem to be particularly good with fibromyalgia pain and nerve pain.  Lyrica made me gain 16 pounds in 2 weeks; so I came off that.  Initially I had trouble with Neurontin, memory problems, word finding, etc.  I was working from home at the time and I went off it as I was making errors.  I'm back on Neurontin now.  I've started at a lower dose and we'll increase it slowly.  So far I'm not seeing much reduction in pain but that may because I am on a low dose.  Doing it this way, though, I have not had the side effects I did before.

Any medication can cause almost any side effect.  Everyone is different.  I didn't have any taste problems on the Tramadol.  I did lose a lot of weight, though, when I was on other pain meds.  And at one point I was on Fentanyl, and it completely changed my taste.  I never was much for sugar but even now that I'm off it, I have to add sugar to things I never did (tea, coffee.)  It was just how it affected me.

I hope you'll call your doctor ASAP and let them know you want to come in and talk about your medications.  No one should suffer in pain.  It can be hard to have a frank talk with our doctors sometimes, but it has to be done.  Otherwise, they can't give us the best care available.

I hope you will let us know how things go, and I hope you'll keep posting and become an active member here.  This is such a great forum for support!

[femmy29]

Hi thirdeye,

I didn't have any issues with weight or taste while on Tramadol but my memory is foggy.  What I do remember is how terrible the mornings on the weekends used to be while on Tramadol.  I would sleep in later on the weekends, and therefore, the Tramadol would completely run out of my system during the 10 hours I slept.  I would wake up feeling like jumping out of skin, with shaking and I was very clumsy and dropped a lot of things.  Shortly after I took my morning dose, that feeling would go away.  And I hated that!  That is when I knew that my body was dependant on Tramadol.  I don't know if you experience anything similar???

Norco is Vicodin with less acetaminophen.  Does the Klonopin help your pain too?  I take Valium for anxiety but also for pain as it is a very potent muscle relaxer.  I believe Klonopin is very similar to Valium and is in the benzodiazepine family.  I used to take 2-3 mg of Valium at night with Vicodin and that combo was safe.  They are both Central Nervous System depressants so the effects are additive.

Years ago I tried Chiropractic and it did help (A LOT, actually).  They had a roller bed with TENS therapy and physical therapy along with the addjustments.  I was receiving care through auto insurance due to the car accident I was in.  I was going 3x a week until my benefits ran out.  After that, I could only afford to go twice a month and at that frequency, they weren't helping me any more.  I am not sure how frequently you go to chiropratic but that could be factor in why it isn't working.  

I am concerned that you aren't feeling much in terms of pain relief from the addjustments.  Chiropractors are a double edged sword, they can help some pain conditions extremely but others, they can make worse.  Have you had an MRI done?  At the bottom of your post, you state that you have multiple bulges in the neck along with tears in the discs and stenosis.  For these types of ailments, chiropractic can worsen these conditions.

Don't be afraid to tell your doctor that the Tramadol isn't working.  There are many other medications out there for you to try.  The Norco is a little stronger than Tramadol, which explains the pain relief that you are getting.  I really hope that they can fix your condition so that you don't have to deal with pain anymore but a lot of times that doesn't occur.  Back surgery has a 60% success rate and many have ended up in worse pain than before the surgery.  It is OK to take pain medications to control pain.  Many of us (including myself) have accepted that pain medications will be a part of our lives until the end.  Pain medications can be very helpful in managing chronic pain so that the person can live as close to a normal life as possible.  Don't beat yourself up for needing pain meds.  I was afraid at first too when the Tramadol stopped working mostly because when I was first prescribed Tramadol, I was told that it was the "end of the road" but it is not.

Also, ask your physician about other meds that can be added to control your pain.  I also take Gabapentin, Remeron, Flexeril, and Valium in addition to Morphine ER and Percocet.  All of these together help a lot with my reducing my pain levels.  Tell him/her what are limitations due to pain.  Tell him/her what you would like to be able to do that you used to be able to do.  Explain what makes your pain better and what makes it worse.  I really encourage you to speak up and not suffer in silence.  You sound like you have been a very compliant patient, so I don't think you will run into any issues.  :)

[thirdeye33]

Thanks so much for caring and understanding. I'm so tired, but I have questions for you all. I'll get back to this post a little more later. I'm also upset, had maybe a reality check,, I think I'm already addicted/craving to Tramadol. I'm a person who was in such great health/athlete and never took anything prior to this damn accident. I'm so frustrated. I do feel like the Chiropractor is maybe making things worse, but she tells me my spine is crooked(prior) and now I developed this forward head lean from the neck injury and that my left leg is shorter. She says all this has improved since we started like 24 sessions ago, but I still feel like crap. I don't know, I do trust her since she is a old family friend, but I nothing is working and I just feel like there should be some way to correct this. I want it FIXED, not masked w/ meds. It's my fault w/ the docs sometimes, I don't speak up enough. Well, I mad as hell now, so I have some aggression for when I see my Chiro this week and pain management doctor. My PT is awesome and so gentle, treats me like a china doll. He use to be the athletic trainer for the NY Rangers(for what it's worth) but he def understands me and knows his stuff and is very protective of my neck.

@femmy29  Just a side note ? from someone who was on Tramadol for a long time.....did you lose weight or have taste issues w/ it?  I've lost 12 pounds in 5 months and I went from being a gym rat to doing nothing and everything taste odd. I haven't really been eating any less. My neuro said that I also have a mild traumatic brain injury and that messes w/ taste...again I just don't know anymore?? I'm suppose to be getting cognitive therapy for that too, but I'm so overwhelmed already. I'll get to it, right now I take 3mg. a day of Klonopin for my anxiety and PTSD.  
Also, I just decided today to take a Norco I had left from an old root canal and my pain has been a little better today(not sure if I should have done that??) I'm not taking Tramadol today, just the Norco and the Klonopin. My pharmacist says that combo is safe.

Ok, anyway I hope I'm not sounded like a nut, the pain is making feel so crazed. I just want a doctor to listen to me.

[femmy29]

Hi There!

I am so sorry to hear that the Tramadol is no longer controlling your pain.  I am in aggreement with what others have posted.  Tramadol binds to opioid recepters in the brain and spinal cord but also have a secondary mode of action that increases serotonin in the brain just like a pure anti-depressant.  Nucynta is known as Tramadol's big both as it works in a similar way but is stronger.  Given the rising cases of addiction with Tramadol, the FDA scheduled Nucynta as a CII prescription.  In most of the US, Tramadol isn't scheduled but it ranges from over the counter availability to a schedule substance in various countries across the world.

I was prescribed Tramadol for pain 6 years ago and was on the maximum pharmaceutical dose of 400 mg per day for 4 years.  It's effectiveness tapered fairly rapidly; however, I considered it better than nothing as my pain levels were not up to what they were originally but I was in more pain than I was after first starting the Tramadol and the pain was increasing as time went on.  It finally got to the point where they were only taking half the edge off and only for about 15 mins before increasing back to the initial pain level.  My PCP swiched out half my Tramadol prescription for Vicodin (two 5/500s twice a day with two 50 mg Tramadol twice a day).  Even with the switchout of Tramadol with Vicodin, I got horrendous withdrawal symptoms (chills, shakes, feeling like jumping out of my skin).  My PCP prescribed Ativan to get me through that rough period.  

The half Tramadol and half Vicodin got me by for about 4 months and the pain began to get unbearable again.  This leads me to where I am now on pain meds (and the road here was not very smooth).  I remained vocal about my pain and that my life was slowly being sucked away before my eyes but all I got was IGNORED.  For months this went on and I continued to take the Tramadol and Vicodin.  Finally, when my concerns about my bp were going unheard as well and I began to have chest pains, I said to myself, that this is ENOUGH!  I went in to see one of his other physicians primarily for high blood pressure as I was being turned away for my epidurals because my bp was too high and those injections were a huge part of my pain relief.  While I was there, I expressed my concerns about pain and that my physician wasn't listening to me.  She dumped me off the Tramadol and Vicodin and put me on Percocet one 5/325 tablet every six hours.  I am sure all of you can imagine what result I had from that change.  

The switch to that amount of Percocet was no where near helpful for my pain.  The pain became so excruciating over the weekend I was prescribed that dose of Percocet.  I couldn't sleep, sit or stand, I was completely miserable.  I went in to my regular PCP that following Mon. and explained what happened.  And, I finally told him that I was tired of chasing pain all day and most of the time, pain wins.  I told him that I heard extended release medications could provide pain relief that was more steady.  I was switched to Morphine with Percocet for breakthrough pain and that is what I am still on today.  Amazingly, I didn't not get Tramadol withdrawal symptoms when I stopped taking the two 50 mg tabs twice a day.  I have been completely off Tramadol since April of this year.

I had to have my medication tweaked a couple of times but now I have a good pain relief throughout the day.  There are many other combinations as others said, and it may take some trial and error until you find that works.  I wish you all the best on your quest for pain relief.

[mellie4]

I tend to agree with Ghilly as far as the chiropractor goes.  And the PT.  PT is useful at certain times as long as you have some very experienced.  Many years ago I had to go to PT for my back.  I was going for about 4 months when they realized they were treating the wrong problem.  Luckily it didn't cause any permanent damage but it hindered my recovery and I lost a lot of time.

At least until you get out of this flare-up, I would think you'd want to be extra careful.  And it is true that Tramadol can be very hard for people to get off.  It also has an antidepressant component to it, which also comes into play when you want to get off it.  (Switching to a narcotic would likely cover any problems in stopping the Tramadol.  So there's no worry there.)

Hopefully if you call your doctor, they'll get back to you and have some recommendations that will give you a little relief until you can get in to see them.  I would hope they'd see you Monday (if they're open.)  Switching meds, I think, should be talked about in person.  There's a lot to think about in choosing the right one.  And if your pain isn't helped at all with what you're on, maybe a long-acting med along with something for breakthrough pain would be something to think about while you're having such a hard time.

[Ghilly]

This is just my own opinion, but I would stop going the chirpractic route and either go to an orthopedic doctor or just stick with pain management.  Depending on your injuries, chiropractics are not going to help and they could make you worse.  None of the orthopedic doctors or pain management docs I have ever gone to have ever recommended chiropractors at all.  

As far as your meds go, I would also look to switch to something besides tramadol.  Ultram (tramadol) is thought to be safe because it is technically not a narcotic, however its mode of action is that it still attaches itself to the mu receptor in the brain, which is the same receptor that opioids attach to.  This means that you can become horribly addicted to tramadol even though it isn't a narcotic, and it is more difficult to stop or withdraw from than most actual narcotics are.  What is even more unfortunate is that as a pain med, it is actually one of the weaker ones.  So you won't get all that much relief from it and you stand a chance of becoming addicted to it anyway.  You would actually, in my opinion, be much better off just biting the bullet and taking an actual opioid.  It would help your pain more efficiently.  

I would call your PM doc again even though it's the weekend.  They all have answering services and for the money they charge (whether we pay them ourselves or our insurance pays them) you deserve a call back even though the office is closed.   If you STILL don't get a call back, first thing Monday morning call the office and demand to speak to him.  It's unconscionable that he allow you to sit all weekend knowing you are in pain without at least giving you the courtesy of a call back.   Depending on his reasons for not causing you back, I would even look for another PM doc.  

I really hope you start to feel better and get some relief from your pain!  And I hope your doctor calls you back soon and doesn't make you sit any longer without relief!

Ghilly

[mellie4]

Lidoderm patches are a prescription.  They can be cut to fit small areas or left the way they come and you can use more than one.  I don't find them to be a help on their own but in conjunction with other things I think they help a little.

The lidocaine infusions are not steroids.  It's more like the novacaine you get at the dentist.  I had it for RSD pain that came from an unsuccessful joint implant in my thumb.  It's also used for fibromyalgia.  Some people get great success from one, others need a series, and some get no relief.

It's not invasive.  I have it done at the pain clinic.  They put in an IV and the anesthesiologist stays and infuses it slowly.  If you feel like it's too much, he'll stop it or slow it down.  The best way to describe the feeling of it is you feel a little drunk.  You may slur your words a little.  It's a very temporary feeling (though I don't care for it.)  I will say during the infusion it will bring my pain down to near zero.  Unfortunately for me, it doesn't last long, maybe a couple of days.

I've also had stellate ganglion blocks.  That's a little more invasive.  They give you an injection into your neck and it's supposed to block the sympathetic nerve from firing off.  I had longer relief with that, maybe a couple of weeks (not pain free but much better.)  It's not painful but it makes me feel a little anxious ... more the thought of getting a needle in the neck more than anything else.

Where you're already on so much Tramadol, maybe you can talk to your doctor about trying a different medication.  There's so many to try and you do have to give it time when switching.

I hope you'll let us know how things go and what you and your doctor come up with, whether it's a new med or upping the one you're on now.

[thirdeye33]

Thanks for getting back to me. I agree, everyone reacts different to meds. I just get so nervous about feeling even worse. I was only going to speak to him to up a dosage. I'm hoping to get in next week and go over another plan. I do also think it might be flaring up from adding the PT. It's complicated cause, the person who hit me was uninsured and in NY, everything medical is done under no-fault. I'm limited to what doctors I can see, how many times,etc. I don't want to complain and lose either chiropractor or PT.

What is this lidocaine infusion? That sounds like it is NOT a steroid, which is what I am looking for. What injury/pain did you have it for? Is it invasive?
Lidoderm patches would be a prescription I assume?

Thanks for the help!

[mellie4]

Sorry you're having such a bad time with your pain!  I think it's hard to go by what other people take.  We're all different and what works for one doesn't necessarily work for another.

It's a shame your pain management doctor didn't call you back.  GIven that it's a long weekend, he really should have.  That's one of my pet peeves!  I want a doctor who is responsive if I call.  I feel like I don't call all the time and if I do, it's because I'm having a bad flare-up.

You can read posts about what people have taken and how it's worked for them.  I was given Tramadol years ago.  I stopped it because I had some side effects that I found to be intolerable.

Do you feel like the chiropractor helps your pain?  Do you do anything other than the Tramadol and the Zanaflex?  I'm wondering if either going to the chiropractor or going to PT contributed to your flare-up?

It sounds like where you are right now requires you to see your doctor in person rather than over the phone.  If the Tramadol isn't working at the high dose you're on, it seems like you need to try something else.   It's one thing to call the doctor and have them prescribe a change in the dosage or how often you take it over the phone, but I think when you're looking to change to a new med, it's best to do that in person.

I'm sure you know all the different pain medications that are used.  Maybe you need to be on a long-acting medication and then have something for breakthrough pain.  There are so many different medications that you can use and so many different combinations.  It's really a trial and error for everyone and that can be really frustrating when you're in pain.

Have you had any procedures done?  Is there anything other than epidural injections available for you?  I had a lidocaine infusion done on two separate occasions.  I'm not sure if that is something that would help you.  I also use lidoderm patches.  That may be something you could try, along with whatever medication you use.  I've found that they are just one more thing in my arsenal to help the pain.  I also use a couple of prescription gels/creams.  For me, I have to put a bunch of things together in order to get some decent pain relief.

I hope when you call your doctor you'll ask them to put you in for an emergency appointment.  They should accommodate you with this since you're having such a hard time.  And I hope they're open on Monday!

For now, I guess you'll have to do whatever you have to do to get through the weekend.  Do you take any ibuprofen?  I've found that helps whatever med I'm on to work a little better and a little longer.  It actually works on any inflammation as well as helping with the pain.  Hope you feel better.